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Autologous Fat Transfer for Thumb Carpometacarpal Joint Osteoarthritis: A Prospective Study

Herold, Christian M.D.; Rennekampff, Hans-Oliver M.D.; Groddeck, Robert M.D.; Allert, Sixtus M.D.

Plastic and Reconstructive Surgery: August 2017 - Volume 140 - Issue 2 - p 327–335
doi: 10.1097/PRS.0000000000003510
Hand/Peripheral Nerve: Original Articles
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Discussion

Background: Most operations for carpometacarpal joint osteoarthritis of the thumb irreversibly alter or destroy the anatomy. There is a high demand for minimally invasive alternatives. The authors report the results of autologous fat transfer for treatment of thumb carpometacarpal joint osteoarthritis.

Methods: In a prospective study, 50 patients with thumb carpometacarpal joint osteoarthritis were observed for 1 year after autologous fat transfer. Manual liposuction and centrifugation were performed. Pain rating according to visual analogue pain scale; objective force of pinch grip and fist closure; and Disabilities of the Arm, Shoulder, and Hand questionnaire scores before and after treatment were analyzed.

Results: The average pain in stage 2 patients preoperatively was 7.7 ± 1.3; it was 1.8 ± 1.9 after 6 months and 2.4 ± 3.1 after 12 months. Patients with stage 2 osteoarthritis demonstrated a superior benefit from this treatment compared with patients with either stage 3 or stage 4 thumb carpometacarpal joint osteoarthritis. There were similar improvements for the parameters strength and Disabilities of the Arm, Shoulder, and Hand questionnaire score. No serious adverse events were observed.

Conclusions: Autologous fat transplantation is an appealing alternative, especially in early-stage basal joint osteoarthritis of the thumb. The low invasiveness of the procedure and early recovery of patients compared with classical procedures such as trapeziectomy, and the superior long-term results compared with classical injection therapy, make this approach feasible as a first-line therapy in early-stage basal joint osteoarthritis of the thumb.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Hameln, Leverkusen, and Oldenburg, Germany

From the Department of Plastic, Aesthetic Surgery, and Hand Surgery, Sana Klinikum Hameln Pyrmont; Plastic and Aesthetic Surgery, Department of Orthopaedic, Trauma, Hand, and Reconstructive Surgery, Klinikum Leverkusen; and the Klinik für Kinder- und Jugendpsychiatrie/Psychosomatik und Psychotherapie, Klinikum Oldenburg.

Received for publication November 6, 2016; accepted February 7, 2017.

Presented in part at the 57th Congress of the Deutsche Gesellschaft für Handchirurgie, in Frankfurt, Germany, September 22 through 24, 2016.

Disclosure: The authors declare that they have no conflicts of interest. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Digital Media” tab to watch. On the iPad, tap on the Hot Topics icon.

Christian Herold, M.D., Department of Plastic and Aesthetic Surgery, Sana Klinikum Hameln-Pyrmont, St. Maur Platz 1, 31785 Hameln, Germany, christianherold@gmx.de

©2017American Society of Plastic Surgeons